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Her job: planning for your nightmare

Pam Blixt helps coordinate the mass quarantines and immunizations needed if bioterror hits Minneapolis -- and she may need your help

Quarantines and mass immunization clinics -- part of public health's past -- could make a comeback, said Pam Blixt, emergency preparedness coordinator for the Minneapolis Health and Family Services Department.

Blixt's job: preparing for worst-case scenarios.

Should Minneapolis get hit with a bioterrorist attack such as anthrax or smallpox -- or the unintentional but also deadly flu pandemic -- Blixt and other health officials must ensure, that they could vaccinate or get antibiotics to all 382,618 Minneapolitans in three to five days.

To stop diseases that are not treatable, such as Severe Acute Respiratory Syndrome (SARS), Blixt helps devise in-home quarantine procedures. (Toronto and Ontario officials quarantined 27,000 people to contain the two SARS outbreaks earlier this year that killed at least 38 people, according to published reports.)

Decades ago, school nurses distributed sugar cubes with polio vaccine to a gym-full of students. Public Health's history includes quarantines for people with tuberculosis, smallpox or yellow fever. But Public Health has never been in the emergency preparedness business, Blixt said.

"It is a new role for us. We are not used to thinking of responding 24/7. That is what we are being asked to do now."

At the office At a time of tight city budgets, federal bioterrorism funds have given Public Health a money injection.

The U.S. Centers for Disease Control (CDC) ramped up spending in the wake of the East Coast anthrax scare. The state of Minnesota received $16 million, a state official said. Of that, Minneapolis got $515,000 this year, the sole source of Blixt's budget. Hennepin County Public Health received $650,000.

Blixt has worked in healthcare for 20 years; for 13 years, she ran Open Circle, a Hopkins-based adult daycare program. She is vice president of the Minnehaha Creek Watershed District, a body that regulates the creek's water quality and flow across 27 cities and a few townships.

Blixt said her watershed work, more than her healthcare background, prepared her for her current job.

"Watersheds don't look at political boundaries, they look at more natural boundaries based on the environment," she said. "In the emergency preparedness business -- at least for health -- that is going to be the case. Diseases will quickly cross political boundaries. That is why so much of the work we are doing is being done collaboratively, on a regional level. Someone could get exposed to something at the Metrodome, go home to Plymouth, and go to Methodist Hospital [in St. Louis Park]."

Blixt works from a fifth-floor cubicle in the city's Public Service Building, 250 S. 4th St. Shore bird posters decorate her workstation. An old-fashioned gas mask hangs on the wall, as does an "E. coli happens" bumper sticker.

A sheet of paper taped to the walls reads:

"Plans should be prepared for the establishment of adequate laboratory and vaccine production facilities and stockpiles of essential basic medical supplies in the event the danger from an enemy attack appears imminent...."

It is from a committee report on biological warfare done for the secretary of defense, dated July 11, 1949.

When 'normal life' stops Blixt has a two-plus person staff, counting herself, which seems meager to handle a major disease outbreak.

In a crisis, however, everyone in the 75-person Public Health Department would respond, Blixt said.

"In an emergency, normal life stops," she said. "You bring everybody on, and everybody starts working the emergency. That is part of the overall planning -- building capacity in the department."

In some scenarios, staff members drop what they are doing and take positions in a mass immunization clinic, in other scenarios, they make phone calls to check on people under in-home quarantine.

Blixt's staff training involves an army of acronyms, such as MIMS (the Minnesota Incident Management System) and C-FLOP (Command: Finances, Logistics, Operations and Planning).

Blixt explained the dense MIMS organizational chart, which outlines the Health Department staff's jobs in a mass immunization clinic. They range from the obvious tasks of injector and first aid administrator to the more mundane tasks of greeter; transportation provider; forms clerk; and phones, faxes and data entry worker.

Recruiting volunteers Mary Jo Fritz, Hennepin County Community Health's emergency preparedness supervisor, said the county is still working to identify potential clinic sites and negotiating agreements.

In Downtown, for instance, it has considered the Target Center and Convention Center, but nothing is final.

Hennepin County would run the mass clinics; Minneapolis Public Health would help staff them. And as it stands now, the county is very short-staffed for an emergency response and needs to find volunteers.

The county is training its 360 health department employees for a crisis, so between the city and county Health Departments, there are 435 potential clinic workers.

However, 6,000 workers a day would be needed to staff mass clinics countywide in the worst-case scenario.

To inoculate each Minneapolitan in a three-to-five-day period, clinics would have to process between 3,188 and 5,314 people an hour, 24 hours a day.

Are we ready to do it? "We have the foundation for doing it," Fritz said. "It is not perfect, and it is not done. It would be difficult to do in three to five days. We are better prepared now than we were a year ago."

Hennepin County Medical Center, Hennepin County and Minneapolis have a federal grant to create a Medical Reserve Corps, "a program to look for medical volunteers that we can get pre-identified, pretrained, precredentialed and be ready to call on if we have to do something like this," Fritz said.

The county is recruiting public health professionals, practicing or retired doctors, nurses, dentists, therapists, social workers, interpreters, chaplains and others with emergency response skills. For more information, call 952-351-5234 or check the Web site www.mrc-hennepin.org.

Quarantine: The Toronto scenario On a recent November morning in a St. Paul office building, emergency planning staff from around the metro area spent four hours playing out how various agencies would respond to an outbreak of SARS, a respiratory illness with no vaccine nor drug cure, spread by coughing and sneezing.

The CDC money doesn't require health officials plan for SARS, but antiterrorism money's spin-off benefit is better preparing the area to respond to naturally occurring epidemics.

Debra Ehret, an emergency preparedness consultant with the Minnesota Department of Health, helped run the exercise, where a hypothetical Ramsey County family of five visited Taiwan and returned with SARS.

As the exercise played out, each county had SARS cases, including two in Minneapolis -- a homeless person and someone who could not speak English.

Kristi Rollwagen, a Minneapolis Fire Department employee and the city's emergency preparedness coordinator, said the biggest questions raised for city staff revolved around quarantines.

"One thing left unresolved -- at least from the local perspective -- is the expectation of who was going to quarantine, how it is going to be carried out and who is going to implement it?" Rollwagen said.

Steve Shakman, a state health department legal affairs coordinator, said the state is learning from Toronto's experience.

The state is planning a three-tiered approach, Shakman said. People who have come in contact with SARS would be asked to do a voluntary in-home quarantine. If monitors found they did not keep the quarantine, the state or county attorney could seek an order for mandatory monitoring. If someone violated the order, public attorneys could seek stricter out-of-home placements.

In the Toronto and surrounding area, health officials only issued 65 warnings, and went to court once, Shakman said.

State public health officials would handle a small SARS outbreak and bring in local public health staff if it could not keep up with demand. Ehret said Minneapolis and other local public health staff would monitor in-home quarantines.

"The second major responsibility would be providing services to those individuals should they need assistance with food, prescriptions, mental health support or counseling, transportation to clinic appointments if the person did not have family members or care providers," she said.

Blixt said providing such support would be a daunting task and local health officials are wrestling with it.

Special assignments Public Health officials from Minneapolis, Hennepin County, other metro counties and the state meet for three hours every other week to plan for emergency responses, Ehret said. They talk about SARS, coordinating metro clinics, training staff and dealing with schools.

Minneapolis heads up discussions in several key areas. It has a lead role in addressing the needs of vulnerable or non-English-speaking residents in the event of a biological attack or epidemic.

Two AmeriCorps/VISTA workers help the city work with organizations that serve elderly, disabled and/or non-English-speaking people, Blixt said. They are trying to ensure those vulnerable groups have the information, support and services they need for up to 72 hours after the start of a disaster.

The city is trying to create a program other communities could replicate, Blixt said.

Minneapolis officials also are spearheading the discussion about the "mental health" response to a terrorist attack.

Ehret said the metro area has to be ready to provide immediate mental health services to 12,000 people immediately following a biological attack or other public health emergency, under federal standards.

Blixt said she and other public health officials are working with hospitals on the mental health effort. She co-chairs a committee with Greg Bodine, a chaplain at North Memorial Hospital. They plan to launch a larger task force in January, she said.

Part of the plan would be basic communication, she said -- giving people accurate information on specific diseases, their risks and what people need to do to protect themselves, Blixt said. It would help reduce panic.

"One of the things Minneapolis is interested in is, what are we going to do to make sure the impact of some terrorism event will not take down our whole economy."